vent: Mom's doc is a quack!

[maolin]

Just a vent here - so frustrated! Mom is 3 hrs away. Hx COPD, HTN, pituitary tumor & anxiety DO. I've never liked her primary MD (Mom also sees pulmonary, endocrine & psych MD's) Primary (family med) is VERY liberal with the psych rx's (dispite specialist) and ALWAYS rx's abx for viral infections. I could write volumes on why this doc is incompetent. But lets just discuss the most recent (and scariest) incident....

Mom had chest pain x5-7 days. Wouldn't go away after antacids, but wasn't major pain, so she put it off. No change with or without exersion, constant sternal @ 3-5/10. Finally went to see primary Thursday. BP was normal 124/82, HR 60 (low for her). MD did EKG in office, showed very slight ST elevation, "possible septal ischemia". Doc ordered CBC only (no card enzymes, no chemistries - not ordered STAT or even NOW - results just came in today (4 days later!!!), completely normal). Doc rx'd naproxen & [MORE] xanax, rescheduled follow up ekg in 2 weeks. Last ekg 2 yrs ago was normal. And I won't even get into the fact that nitro SL wasn't even thought of! Grrr!!!

Sure, it could be anxiety or muscle strain as doc told her. But I can't comprehend why (in light of ABNORMAL EKG & symptomatic) that enzymes & chemistries weren't run to rule in/out cardiac vs. GERD vs. muscle strain. Maybe my train of thought goes straight to angina/MI because I'm CCU. I just assume that chemistries & enzymes would be a fundamental step.

I wish she would run away from this doc - but she just won't (unlimited, unquestioned rx supply - why would she?). I did talk her into calling her pulmonary MD about this - they are going to review the ekg & get those other labs (at my insistance) and refer to cardiologist if labs indicate.

Thanks for listening. *sigh*

[Ophelia78]

Would your mom be willing to go to the ER next time for CP? I would call sternal pain an emergency. Women don't always present with all the classic symptoms of an MI. Would she be willing to switch to a different primary?

Of course, I do have a friend who spent the last 6 weeks with chest pain. Multiple trips to the ER. EKG fine, vitals stable, lipids and enzymes WNL. Young, 41, in good shape, nonsmoker. He finally couldn't take it anymore and begged the cardio to take a closer look. They took him to the cath lab and lo and behold, his LAD was 90% occluded. He ended up with a stent last week. The doc said it probably had genetic influences. Both his parents died in their 40s/50s of heart disease.

[teeituptom, BSN, RN]

Send her to the ER

There you are guilty untill proven innocent

[maolin]

After my nagging for 4 days, she's finally taking it seriously. Her pulmonologist reviwed & referred to cardiologist. She's going in for a full cardio workup tomorrow (treadmill stress, nuclear stress, echo, labs). Hopefully its nothing serious, but we'll have concete data. She's finally starting to believe that maybe her PCP is incompetent afterall.

[maolin]

Update: She went to the cardiologist & got the works. Labs were all ok.

Just got results of nuclear stress this morning and she's won a trip to the cath lab. Fortunately, it isn't an emergency - he'll do it early next week. Says likely to need a stent placed in the LAD.

I hate being right, but so glad I'm a nurse and recognized the PCP's incompetence. I hate to imagine what would have happened if I weren't a nurse.

[creature]

Should have went right to ER. Any chest pain is considered an MI until proven otherwise in my book.

[UM Review RN, ASN, RN]

Should have went right to ER. Any chest pain is considered an MI until proven otherwise in my book.

Big amen from this Tele corner!

[maolin]

I couldn't agree more. Sadly, my mother is the epitomy of non compliance (I could hear her smoking when she called me with the news). Denial (D-Nile) isn't just a river in Egypt.

I spoke to the cardiologist (who is wonderful btw!!) and he said she was told during the first visit to call him if she continued to have CP and used the NTG spray he rx'd. He hadn't heard from her since the tests, so he called to follow up. She then told him she had been using the NTG all week when she had CP and "Boy, did it really help with the pain!". She didn't tell me she'd still been having the pain - and I went to see her last weekend! She's a lousy patient - and I'm afriad i'm going to be THAT family member we all dread - the "Daughter whose a nurse"!!! AAccckkkk!!!

[creature]

Dear Maolin,

I feel for you. Luckily my parents are fairly young and free from any serious health problems, but I do take care of my 87 year old grandmother who still drives, plays cards, goes to church daily. She has more of a social life than I do, but boy things can sure turn around fast. She has chronic UTIs and she gets a little fever and goes bonkers. I am so glad I have gotten to know her more in these last few years though. I guess it's all worth it in the end. You just have to take them with a grain of salt and do the best you can. Sometimes they will frustrate the heck out of you, but just hang in there and know that nobody could be taking better care of her than a nurse and a daughter.